Monday, November 15, 2010

Lip Service: The Health Risks of Oral Sex

Major, major ladies - take care of yourselves, HPV is finding its way into your mouths.

Health Risks of Oral Sex

Long known to cause cervical cancer, the pervasive but often silent human papillomavirus (HPV) has been finding its way into women's mouths

By Alyssa Giacobbe

Mische Eddins, 37, awoke with a head cold. Or what seemed like one anyway. Postnasal drip. Sore throat. Swollen lymph nodes. No biggie—it was the fall of 2007, and a seasonal bug was winding its way through Seattle. "I had just been bragging to my friends about how I'd managed to avoid getting sick," she says. "But I was healthy, so it all passed quickly." Everything, that is, except a swollen node on the left side of her neck, which, months later, hadn't gone away.

Christmastime came, and the little bump was still there. Sans appointment, Mische walked into her doctor's office and left with a script for antibiotics. No improvement. She then bounced from M.D. to M.D., and finally, six months after that seemingly innocuous head cold, she had a PET/CT scan. The results were a total shock: Mische had stage III oral cancer, and the disease had spread from her tonsil to her lymph nodes.

Within hours, her docs had scheduled a tonsillectomy and were talking about chemo and radiation. Someone suggested she prepare a will. "I was floored," she says. "A will?" A professional singer, Mische exercised almost every day, ate a mostly organic diet, didn't booze heavily, and never smoked as an adult. Even her doctors were stymied.

Searching for answers, one physician tested Mische's cancer cells for human papillomavirus (HPV), the sexually transmitted infection notoriously linked to cervical cancer. Mische was taken aback; she'd spent the past 16 years in two monogamous relationships and was fastidious about getting annual Pap smears, which had never been abnormal. Why were they now testing her mouth? Her doctors explained the worrisome new link between oral cancer and HPV, which can be transmitted to the mouth through oral sex. And indeed, she tested positive. Her oral cancer was HPV-related.

Ten years ago, oral cancer among women was practically unheard of. Patients were nearly always male and over 50, heavy smokers or drinkers, or both. (When actor Michael Douglas, 66, was diagnosed with the illness this past summer, the media pointed to his longtime half-a-pack-a-day habit.) But according to the Journal of Clinical Oncology, there has been a major upswing in HPV-related oropharyngeal cancer, a deadly disease often found in the base of the tongue and the tonsils. In fact, roughly a quarter of all oral cancers are now HPV-related, according to the American Cancer Society, and approximately 25 percent of cases occur in women—some as young as 19, says Gregory Masters, M.D., an oncologist at the Helen F. Graham Cancer Center in Newark, Delaware.

But how could HPV, a "down there" disease, be causing so many mouth problems? It's something the best doctors and public-health experts out there have long feared, thanks to the rampant spread of the virus. You've likely heard the daunting stats: Approximately 20 million Americans currently have HPV, with 6 million new infections discovered each year through Pap or cervical swab tests, according to the Centers for Disease Control and Prevention. What's more, the virus—which can have zero symptoms or bloom into a series of visible warts—will affect up to 80 percent of sexually active women at some point in their lives.

In the vast majority of cases, the body's immune system will clear HPV on its own within two years (there is some debate over whether the same HPV infection can ever return to cause cervical lesions later, but research is still in early stages). However, a small percentage of infected women—around 11,000 per year—will not clear HPV and may develop cervical cancer. This has prompted the federal government to recommend, somewhat controversially, that all girls be vaccinated for HPV by age 12.

To date, safe-sex campaigns have typically blamed the spread of HPV on unprotected vaginal intercourse. But it's now clear that the disease can be contracted orally too. And that's where things got dangerous for Mische Eddins and thousands of other women. Their mouths were infected with HPV-16, the particular type that most doctors believe is responsible for the majority of cases of HPV-related oral cancer.

Just how long HPV-16 lingers in the mouth before turning into cancer is uncertain. But what is evident is that more than 14 percent of cases aren't caught until very late stages, possibly because some physicians are slow to consider the cancer in young female patients. "Since HPV-related oral cancers don't affect the traditional group of those at risk for mouth cancer, a lot of these cases are missed or diagnosed late," affirms Eric J. Moore, M.D., an otolaryngologist at the Mayo Clinic in Rochester, Minnesota. "Usually, the patient is healthy, exercises regularly, and eats right. She doesn't fit the profile."

Founder Natalie Blacker's future plans for Ladies Lotto include expanding the overall brand and its network into new major markets, as well as the development of a grant foundation to further its members, an annual conference of member-driven lectures and forums, and collective productions in both music and print media.